Seventy day old female infant presented with respiratory distress from
55 days of life. neonatal period was uneventful. Chest X-ray
revealed opacities of the right upper and middle lobe. This child
received parenteral ceftriaxone and oral azithromycin prior to coming to
our hospital. Repeat X-ray was similar to the initial one.
Clinically, child had dyspnea, tachypnea and required oxygen to maintain
100% SPO2. In view of persistent pneumonia child was subjected to bronchoscopy and bronchoalveolar lavage secretions were sent for
acid-fast bacilli smear and culture. Smear for acid-fast bacillus was
positive and hence antituberculous drugs (2HRZE) were started pending
culture report. Initial cultures had grown M. chelonae, which is
atypical mycobacteria and is usually a contaminant. Hence,
anti-tubercular drugs were continued. Final cultures revealed overgrowth
of M. Chelonae and no growth of Mycobacterium tuberculosis.There
was no significant improvement after 2 weeks of antituberculous
treatment. Hence we considered M.chelonae as pathogenic and
started the child on oral Ofloxacin and Clarithromycin to which it is
usually sensitive. Antituberculous drugs were discontinued, as M.
chelonae is resistant to the conventional anti-tuberculous drugs.
Two weeks after specific treatment, there was significant improvement in
the clinical condition and four weeks later there was near total
clearance of radiological lesions.
M. chelonae is an atypical mycobacteria and a
rare cause of pulmonary infection in children. They are rapid growers
and usually outgrow the media. It usually causes cervical lymphadenitis
and disseminated disease in immunocompromised children and children with
cystic fibrosis(1). In this child the immunological status was normal as
evidenced by normal immunoglobulin profile and negative screening for
HIV by ELISA. The American Thoracic Society(2) recommends the following
criteria for diagnosing pathogenic infections caused by atypical
mycobacteria and our child satisfied all those criteria: namely
radiological changes, isolation of multiple colonies of the same
pathogen and absence of other potential pathogens. The treatment of
M. chelonae is not yet standardized; however sensitivity to
macrolides and quinolones has been reported(3).
Department of Pediatrics,
Kanchi Kamakoti Childs Trust Hospital,
12A, Ngeswara Road,
Chennai 600 090, India.
1. Fauroux DB, Clement A. Mycobacterial Lung
Disease in Cystic Fibrosis–A Prospective Study. Pediatric Infec Dis
J.1997; 16: 354-358.
2. J. Thomas Cross, Richard F Jacobs. Other
Mycobacteria.In: Feigin, Cherry, Demmler, Kaplan, eds. Text Book of
Pediatric Infectious Diseases. 5th edn. Saunders. 1379-1390.
3. Dwight A. Powell. Non Tuberculous Mycobacteria. In:
Behrman, Kleigman, Jenson, eds. Nelson Textbook of Pediatrics. 17th
edn. Saunders. pp. 975-977.